Acceptability, appropriateness, and feasibility of antimicrobial stewardship interventions among Swiss primary care physicians, a national, cross-sectional survey

Background
Appropriate use of antibiotics is crucial to limit the worldwide growth of antimicrobial resistance. With most of the antibiotic prescriptions taking place in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by Primary Care Physicians (PCPs) to fully deploy their effects. This is the first nationwide study assessing Swiss PCPs’ views on a broad range of AMS interventions. This might help to design and promote interventions to their targeted population, increase their uptake by PCPs and ultimately impact prescription. The main objective of this study was to evaluate the use, awareness, acceptability, appropriateness, and feasibility of a broad range of AMS interventions available for Swiss PCPs.
Methods
A cross-sectional survey targeted PCPs throughout Switzerland, distributed through Family Medicine Departments’ mailing lists (University of Lausanne, University of Luzern), professional newsletters, and medical education events from December 2023 to March 2024. The survey assessed the use of 16 sources of information about appropriate antibiotic use, considered as AMS interventions. Second, the survey assessed specifically the perceived acceptability, appropriateness, and feasibility of 8 AMS interventions targeting the use of antimicrobials in the management of respiratory tract infections (RTIs), using five-level Likert scales.
Results
Out of the 355 PCPs that took part in the survey, 218 evaluated at least one AMS intervention targeting RTIs. PCPs were most aware of biomarkers to guide antibiotic prescription in RTIs, such as point-of-care procalcitonin (POC-PCT, 67.6%) and C- reactive protein (POC-CRP, 61.1%), and the Federal Office of Public Health’s (FOPH) awareness campaign (57.3%). The national guidelines website was familiar to 52.7% of PCPs. Awareness was lower regarding antibiotic prescription audit and feedback (36.0%), shared decision-making tools (27.0%), factsheets for physicians (22.5%), and communication skills training (17.1%). The national guidelines website emerged as the most acceptable, appropriate, and feasible AMS intervention among Swiss PCPs, scoring 4.20, 4.25, and 4.21 out of 5, respectively. In comparison, the mean scores for all other interventions was 3.84 for acceptability, 3.85 for appropriateness, and 3.76 for feasibility, respectively.
Conclusion
Despite the high perceived acceptability, appropriateness, and feasibility of certain AMS interventions available for respiratory tract infections, their real-life impact may be hindered by low awareness.